Catalog Number 102453307 |
Device Problem
Difficult to Insert (1316)
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Patient Problem
Insufficient Information (4580)
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Event Date 07/27/2023 |
Event Type
malfunction
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Event Description
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It was reported that during the surgery, it was found that the insert could not be locked and it was easy to loosen and pull out.Replacing the insert caused that the procedure delayed by approximately 30 minutes.
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Manufacturer Narrative
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Product complaint # : (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
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Manufacturer Narrative
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Product complaint # (b)(4).Investigation summary: could not lock the insert.During the surgery, it was found that the insert could not be locked.And it was easy to loosen and pull out.After replacing another insert with the same lot number.The loosening situation happened again.Please check the detail in the video which is in the attachment.The doctor decided to continue to complete the surgery, but it may cause potential patient risk.Replacing the insert caused that the procedure delayed by approximately 30 minutes.The patient is stable now.The product was not returned to depuy synthes, however a video was provided for review.See attachment ""(b)(4)"".The video investigation revealed the device is loose on the mating component, however the allegation against the devices not fitting intra-op cannot be confirmed.Ifu-0902-00-806 explicitly states that "do not allow contact of any component with hard objects." and "damage or alterations to any implant component may produce stresses and/or cause defects which could lead to implant failure.", the surgeon is introducing another tool between the sigma hp uni ins sz3 7mm lm/rl and the tibial tray to demonstrate the loosening condition.It is important and stated in ifu-0902-00-806 "that a visual inspection of each implant component for possible imperfections should be performed".Furthermore it is important to note that the final decision of implantation is taken by the surgeon or surgical team and if a possible nonconformance was found on a device the most appropriate course of action would've been to stop the surgical process to diminish a possible risk to the patient.Additionally, with the evidence provided is unknown if there is any debris between the insert and tibial tray that might be contributing with the reported allegation.As the device was not returned, an as-received condition could not be assessed, and a dimensional inspection and document/specification review were not completed.The overall complaint was confirmed as the observed condition of the [sigma hp uni ins sz3 7mm lm/rl] would contribute to the complained device issue.Based on the investigation findings, a potential cause cannot be established due to the limited information provided it has been determined that no corrective and/or preventative action is proposed.There is no indication that a design or manufacturing issue has caused the complaint condition.As part of depuy synthes quality process, all devices are manufactured, inspected, and released to approved specifications.Additional monitoring for any potential safety signals will be conducted through complaint trending and other post-market safety surveillance activities.Device history lot: a manufacturing record evaluation was performed for the finished device jp2291 lot number, and no nonconformances were identified.
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Manufacturer Narrative
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Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
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Search Alerts/Recalls
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